Sam Houston Area Council - Camp Strake - Special Diet Request Form Participants First Name * Participants Last Name * What type of camper are you? * Scout Adult Staff Unit # * Unit Type * Troop Crew Ship District Volunteer Council Volunteer Attending Start Date * First Name of Parent/Guardian * Last Name of Parent/Guardian * Phone * Email * Please identify and describe dietary restrictions in the space below. * List all omitted foods. * Please describe any foods that you need omitted from your meals. List all Acceptable Substitutions * Please describe any substitutions for the foods you need omitted. I, as an authorized person to sign and enter into contracts on behalf of myself or child, understand, acknowledge and agree as follows: * Allergies and special diets are a common concern of our campers. Our food service-providers are very experienced with accommodating most diets, including food allergies, religious restrictions and other health-related diets. We are happy to accommodate any diet for, religious, medical or allergy needs; however, this form must be submitted at least three weeks prior to arrival at camp. Not all diets can be accommodated; we will notify you before the event if accommodations cannot be made. While at camp, campers could be served one of many dining styles such as family style dining, cafeteria style dining and/or self-serve bars. It is the expectation that by participating in the camp program, the camper has the necessary knowledge of their diet and can manage their food choices. Camp cannot guarantee an allergen free environment. Careful consideration needs to be taken for campers with severe allergies, particularly those susceptible to airborne transmission. If a camper has a severe allergy or dietary restriction, contact the camp directors to discuss if camp is properly equipped to manage needs. While we work to meet all dietary requirements, food is prepared in an area with milk, eggs, peanut, tree nut, wheat, soy, fish and cross contamination may occur. In consideration of the Camper's participation at camp, the Camper (and Parent/Guardian's if a minor is participating) jointly and severally release, forever discharge, hold harmless, and covenant not to sue, Kandle Dining, or any of their related or affiliated entities (the "Sam Houston Area Council Parties") with respect to any injury, loss, or damage, to person or property associated with participation in any Sam Houston Area Council programs, whether arising from negligence or otherwise (the "Claims"). The Camper (and Parent/Guardian's if a minor is participating) jointly and severally indemnify, defend, and hold harmless the Sam Houston Area Council Parties from and against the Claims. The release and indemnity set forth herein shall be unconditional, absolute, and interpreted to the fullest and broadest release and indemnity permitted by law. Upon arrival at camp and prior to their first meal eaten, it is the Camper's (and Parent/Guardian's if a minor is participating) responsibility to identify themselves to our kitchen staff; then cooperate in helping us meet their need(s). By typing your name in this field you are e-signing the information provided is correct on this form. Signature (if 18+) or Parent/Guardian Signature * Date *
